A Time Saving Method to Fabricate a Custom Ocular Prosthesis

Abstract

Ocular prostheses have a long history of successful use. Several variations of the techniques and materials used have been proposed before. The replication of the natural iris by oil painting requires skill and also takes a lot of time. In this article some alternate procedures have been presented to save time while fabrication of a custom ocular prosthesis. Digital photography was used to replicate the iris of the patient, replacing the conventional oil paint technique. Advantages, such as reduced treatment time and increased simplicity make this method an alternative for fabricating ocular prostheses.

Full text

Sandeep Chiramana et al
42 JAYPEE
CASE REPORT
A Time Saving Method to Fabricate a Custom
Ocular Prosthesis
Sandeep Chiramana, Gopinadh Anne, Kavya Ravuri, Phani Praneetha Boppana,
Sampath Kumar, Krishna Chaitanya Appana
ABSTRACT
Ocular prostheses have a long history of successful use. Several
variations of the techniques and materials used have been
proposed before. The replication of the natural iris by oil painting
requires skill and also takes a lot of time. In this article some
alternate procedures have been presented to save time while
fabrication of a custom ocular prosthesis. Digital photography
was used to replicate the iris of the patient, replacing the
conventional oil paint technique. Advantages, such as reduced
treatment time and increased simplicity make this method an
alternative for fabricating ocular prostheses.
Keywords: Ocular prosthesis, Custom-made, Digital iris image,
Time saving.
How to cite this article: Chiramana S, Anne G, Ravuri K,
Boppana PP, Kumar S, Appana KC. A Time Saving Method to
Fabricate a Custom Ocular Prosthesis. J Orofac Res 2013;
3(1):42-45.
Source of support: Nil
Conflict of interest: None declared
INTRODUCTION
‘Eyes are the windows to the soul’ and they are generally
the first features of the face to be noted. An important
component of facial expression, the vital organ of vision
has been given a paramount status for beauty. The loss or
absence of the eye, due to irreparable trauma, tumor, a
painful blind eye, sympathetic ophthalmia, or a congenital
defect1 leaves a person grappling not only with a functional
disability but also the discouraging effect of impaired facial
esthetics.
The importance of an ocular prosthesis with acceptable
esthetics and reasonable motility in restoring normal
appearance in patients with anophthalmia has long been
recognized. Artificial eyes have been in existence since the
very early times in Egypt before 3000 BC and the materials
used varied from clay, leather and cloth to precious gems.
It was only in the 16th century that the prosthesis was made
to fit into a socket. Frenchman Ambroise Pare, a pioneer of
maxillofacial prosthodontics was the first to use both glass
and porcelain eyes. Artificial glass eyes were later replaced
by acrylic during and after the two world wars.2
Several techniques have been used in fitting and
fabricating artificial eyes. Empirically fitting a stock eye,
modifying a stock eye by making an impression of the ocular
10.5005/jp-journals-10026-1062
defect, and the custom eye technique are the most commonly
used techniques.3 The fabrication of a custom acrylic resin
eye provides more esthetic and precise results because an
impression establishes the defect contours, and the iris and
the sclera are custom fabricated and painted.1 The traditional
method of painting the iris demands skill as well as time.
Use of a digital image of the iris of the adjacent normal eye
to duplicate the iris color and its intricacies gives better
esthetics in a fraction of the time required for painting the
iris.1
This case report describes a custom fitted ocular
prosthesis using a digital image of the natural eye.
CLINICAL REPORT
A 40-year-old male patient reported to the Department of
Prosthodontics, Sibar Institute of Dental Sciences, with a
chief complaint of unsatisfactory esthetics of his stock ocular
prosthesis. According to the reports from the ophthalmic
surgeon, he had undergone enucleation of his left eye
following a complication of snake bite 10 years ago and
had been rehabilitated with a stock ocular prosthesis in a
private clinic.
On examination, it was observed that the whole eyeball
was surgically excised, but the muscles at the base of the
socket were intact. The existing prosthesis had poor
retention and did not match the opposite eye (Fig. 1).
A 5 ml disposable syringe without the needle was used
to record the defect using irreversible hydrocolloid
impression material (Fig. 2A). The impression obtained was
invested in a small bowl of dental stone (type III gypsum
product) (Fig. 2B). From the cast obtained, a custom tray
was fabricated with clear acrylic (Fig. 2C, Inset). This tray
was adapted to the tip of an elastomeric automixing syringe.
Fig. 1: Previous stock ocular prosthesis

A Time Saving Method to Fabricate a Custom Ocular Prosthesis
Journal of Orofacial Research, January-March 2013;3(1):42-45
43
JOFR
The final impression was made with light body elastomeric
material (Affinis, Coltene Whaledent) (Fig. 2C).
The impression was then invested in irreversible
hydrocolloid and modeling wax was melted and poured into
the mold space after removing the impression material. This
helped in obtaining the scleral wax pattern almost
immediately. The wax pattern was placed into the defect
and evaluated for esthetics and comfort following which,
the iris plane and pupil point were evaluated by drawing
guide lines on the patient’s face. The contralateral eye was
used as a guide. This pattern was then processed with heat
cure tooth colored (DPI tooth molding powder, D shade)
acrylic resin. The scleral blank was then finished, polished
and tried in the patient’s ocular defect (Fig. 3). In the finished
blank it was ensured that the eye contour and lid
configurations resembled the natural eye of the patient, and
the eyelids closed completely over it.
A digital photograph of the patient’s natural eye was
made while the patient was looking straight ahead. This
image was then edited using Adobe Photoshop and a color
print was obtained on a photo paper. The paper was cut
Figs 2A to C: Impression making
Fig. 3: Scleral blank
Fig. 4: Iris printed on photo paper
along the shape of the iris and coated with cyanoacrylate to
make it water resistant (Fig. 4).
Ocular buttons (Fig. 5) are usually used to attach onto
this paper iris disk.1,2,4 However, in order to obtain the
convex shape of the cornea, self-cure clear acrylic resin
was molded over the iris paper. After finishing and
polishing, the custom-made ocular button was attached
to the scleral blank at the previously determined position
(Fig. 6).
The scleral blank was then prepared for the final layer
of clear acrylic resin on the surface by removing about
1mm of acrylic from its surface. Characterization of the
scleral region was done by attaching red colored silk
threads using monomer polymer syrup (clear acrylic). A
small amount of yellow colored stain was added to the
syrup to obtain the yellowish tinge of the patient’s natural
eye. This prosthesis was then processed after packing a
thin layer of heat cure clear acrylic on the surface of the
characterization. The prosthesis was finished and polished
(Fig. 7) with meticulous care to avoid any sharp areas and
was inserted (Fig. 8).
A
B
C

Sandeep Chiramana et al
44 JAYPEE
Fig. 5: Ocular button
Fig. 6: Positioning of iris portion of eye
Fig. 7: Characterization of the sclera
Fig. 8: Finished ocular prosthesis in place
Post-insertion instructions included regular removal and
cleaning of the prosthesis with an ophthalmic irrigation
solution.4
DISCUSSION
Numerous ocular impression and fitting techniques have
been described in the literature. Most can be placed into
one of several broad categories direct impression/external
impression, impression with a stock ocular tray or modified
stock ocular tray, impression with custom ocular tray,
impression using a stock ocular prosthesis, ocular prosthesis
modification, and the wax scleral blank technique.5 We had
customized the tray prepared from the preliminary
impression to accept the automixing syringe of light body
elastomeric impression material.
For the fabrication of a wax scleral pattern it has been
suggested to make a stone mold and break it after pouring
the wax.3,6-9 It is however a time consuming and
cumbersome procedure. We simplified the process of
obtaining the wax pattern by using irreversible hydrocolloid
to form the mold. It also helped save a lot of time and
material. In the conventional methods for replicating the
iris proposed previously, the paper iris disk technique and
the black iris disk technique, the iris is painted on the ocular
disk using oil paints.2,6 Dos Reis et al10 had evaluated the
color stability of painted iris colors on ocular prosthesis
and concluded that the colors degraded as a function of time.
Artopoulou et al1 suggested the use of digital photography
to replicate the iris of the patient. Though, there are no
studies on the photodegradation of the digitally replicated
iris. It is hoped that it will be more color stable than the
traditionally painted colors. This procedure not only saves
time but also helps obtain a very good replica of the natural
iris with only a few modifications.
SUMMARY
Ocular prostheses have a long history of successful use,
and variations of the techniques and materials used have
been introduced throughout the years. In the technique
described, digital photography is used to replicate the iris
of the patient, replacing the conventional oil paint technique,
which simplified the process of fabrication of a custom
ocular prosthesis. Advantages, such as reduced treatment

A Time Saving Method to Fabricate a Custom Ocular Prosthesis
Journal of Orofacial Research, January-March 2013;3(1):42-45
45
JOFR
time and increased simplicity make this method an
alternative for fabricating ocular prostheses.
REFERENCES
1. Artopoulou I, et al. Digital imaging in the fabrication of ocular
prostheses. J Prosthet Dent 2006;95:327-30.
2. Chalian VA, Drane JB, Standish MS. Maxillofacial prosthetics,
multidisciplinary practice. Baltimore: The Williams & Wilkins
Co 1971:286-93.
3. Bartlett SO, Dorsey JM. Ocular prosthesis: A physiologic
system. J Prosthet Dent 1973;29(4):450-59.
4. Parr GR, Goldman BM, Rahn AO. Post insertion care of the
ocular prosthesis. J Prosthet Dent 1983;49(1):220-24.
5. Ponnanna AA, Porwal A, Verma N. Impressions techniques
for ocular prosthesis: A clinical review. Int J Dent Clin
2009;1(1):27-31.
6. Taylor TD. Clinical maxillofacial prosthetics. Chicago:
Quintessence Pub Co 2000:265-77.
7. Brown KE. Fabrication of an ocular prosthesis. J Prosthet Dent
1970;24 (2):225-35.
8. Kaira LS, Mandal NB, Bharathi S. Prosthodontic rehabilitation
of patient with ocular defect using an alternative technique. J
Orofac Sci 2012;4(1):60-63.
9. Kalavathi SD, Arvind M, Phaneendra K. Restoring ocular esthetics
using ocular prosthesis. J Dent Sci Res 2010;1(2):39-44.
10. Reis R, Dias R, Carvalho JC. Evaluation of iris color stability
in ocular prosthesis. Brazil Dent J 2008;19(4):370-74.
ABOUT THE AUTHORS
Sandeep Chiramana (Corresponding Author)
Professor, Department of Prosthodontics, Sibar Institute of Dental Sciences
Guntur, Andhra Pradesh, India, e-mail: chiramanasandeep@gmail.com
Gopinadh Anne
Professor and Head, Department of Prosthodontics, Sibar Institute of
Dental Sciences, Guntur, Andhra Pradesh, India
Kavya Ravuri
Postgraduate Student, Department of Prosthodontics, Sibar Institute
of Dental Sciences, Guntur, Andhra Pradesh, India
Phani Praneetha Boppana
Postgraduate Student, Department of Prosthodontics, Sibar Institute
of Dental Sciences, Guntur, Andhra Pradesh, India
Sampath Kumar
Postgraduate Student, Department of Prosthodontics, Sibar Institute
of Dental Sciences, Guntur, Andhra Pradesh, India
Krishna Chaitanya Appana
Postgraduate Student, Department of Prosthodontics, Sibar Institute
of Dental Sciences, Guntur, Andhra Pradesh, India